Version 1
: Received: 6 June 2021 / Approved: 8 June 2021 / Online: 8 June 2021 (09:17:40 CEST)
Version 2
: Received: 31 July 2021 / Approved: 2 August 2021 / Online: 2 August 2021 (14:52:46 CEST)
Serrano Afonso, A.; Carnaval, T.; Cés, S.V. Combination Therapy for Neuropathic Pain: A Review of Recent Evidence. J. Clin. Med.2021, 10, 3533.
Serrano Afonso, A.; Carnaval, T.; Cés, S.V. Combination Therapy for Neuropathic Pain: A Review of Recent Evidence. J. Clin. Med. 2021, 10, 3533.
Serrano Afonso, A.; Carnaval, T.; Cés, S.V. Combination Therapy for Neuropathic Pain: A Review of Recent Evidence. J. Clin. Med.2021, 10, 3533.
Serrano Afonso, A.; Carnaval, T.; Cés, S.V. Combination Therapy for Neuropathic Pain: A Review of Recent Evidence. J. Clin. Med. 2021, 10, 3533.
Abstract
Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new, independent review to assess whether more evidence and of better-quality has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded, randomized, controlled trials involving only adult participants and comparing combination therapy (CT: ≥ 2 drugs) to a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze.
Keywords
Neuropathic Pain; Combination Therapy; Pharmacotherapy; Randomized Control Trial
Subject
Medicine and Pharmacology, Immunology and Allergy
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received:
2 August 2021
Commenter:
Ancor Serrano Afonso
Commenter's Conflict of Interests:
Author
Comment:
Tittle changed. Little modifications on abstract and introduction. Some ammendtments in material and methods (clarification of search methods), resulsts (RoB table, and clarifications on effect of interventions) , and in discussion (Figure 2 and clarification on section "potential biases and limitations"). Better english edition.
Commenter: Ancor Serrano Afonso
Commenter's Conflict of Interests: Author